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Veterans Health Administration

VA Asking Vets to Help Design Medication Labels

What’s the first thing you look for when you pick up that little prescription bottle?

The name of the drug?

When are you supposed to take it?

And what is the most important information on the label?

How many milligrams are in each pill?

Are there any side effects?

The telephone number of the VA Medical Center?

The VA is asking about 900 Veterans these questions. And more.

What does this instruction mean? “Take one pill daily with food.”

Would you interpret that to mean that every time you had food that day, you should take this pill? It may seem easy and logical to you but for some patients, it can be confusing.

A Veteran with severe mental health problems may find seemingly simple instructions very complicated and frustrating.

If you were illiterate, would you be able to identify the name of the drug and which word was the name of your doctor? Maybe not.

Should prescription labels be available in the primary language of the Veteran? For example, should prescription labels for the thousands of American Veterans of Hispanic heritage in Puerto Rico be in Spanish?

What would be the best design for a prescription label? Who should you ask?
The Veterans who take the pills.

In an effort to develop a single standardized prescription label for use VA-wide, Veterans at ten VA facilities are being asked to participate in a research study that will allow them to be directly involved.

The study asks Veterans specific questions about preference, usability and jargon interpretation. VA wants to know if Veterans understand the words used on prescription labels.

The survey is voluntary. Veterans and their caregivers can participate.

“It’s very important that we generate interest in this survey,” said Keith Trettin, a VA National Center for Patient Safety (NCPS) program manager and primary investigator.

“We are hoping to get between 60 and 90 Veterans to participate at 10 different VA sites, so that would give us around 900 individuals.”

Actual proposed labels are being presented to Veterans, each having data elements in different areas. The goal is to ensure the final standardized version allows individuals to readily find information and understand what it is used for.

Trettin explained why Veterans’ perspective is central to the research. “It’s important that we actually test the usability of the label with the users — the Veteran and caregiver,” he said.

Currently, there are as many as ten different label formats being used around the VA. Standardizing to one specific label format would be a significant change and could minimize the risk of label-related medication errors.

The impact of a standardized label would be very significant to the entire VA patient population. As Trettin points out, “VA fills 800,000 prescriptions a day.”

“We want the whole process to be patient-centered. We have great recommendations and guidance from expert advisory panels but it’s important that we actually test the usability of the labels with the user — the Veteran and the caregiver.”

Once the final product is approved by VA Pharmacy Benefits Management (PBM) leadership, standardization can take place rapidly, as reformatting for a standardized label will not require significant changes to current software.

Trettin estimates the recommendations could be forwarded to PBM by mid-summer 2011.

Those who choose to participate will answer questions on an anonymous written survey and offer comments during an additional anonymous open comment period.

So far, the study has been conducted at VA Medical Centers in Detroit and Ann Arbor, Mich., Walla, Walla, Wash., and Fayetteville, N.C.

In April, the study will continue at East Orange, N.J., San Juan, Puerto Rico, Honolulu, Hawaii, and Anchorage, Alaska.

The study will conclude in May in Amarillo, Texas, and at Chinle and Second Mesa in Arizona.

Amarillo VA Pharmacist Had the Idea

Much of the credit for the idea of a simple, standardized label for Veterans goes to Joe Youngblood, a pharmacist and patient safety manager at the Amarillo, Texas VA Health Care System.

The Amarillo VA Health Care System was awarded a Patient Safety Initiative grant in 2007 through the VA National Center for Patient Safety. Youngblood used the grant to conduct an investigation on how Veterans at his facility reacted to VA prescription labels.

Joe Youngblood

Joe Youngblood

He presented Veterans with three different label types, with data elements located in different places on each of the labels. It turned out the current label VA was using ended up being the least preferred by Veterans.

Members of the NCPS staff contacted Youngblood and began digging into what is termed “the patient-centered label movement,” with support from members of VA’s PBM.

Erin Narus, NCPS pharmacist working on the project, said, “The part that I think is most exciting is that a lot of the momentum for this project originated at the facility level with the initiative by Joe Youngblood who developed the team at Amarillo to start talking to Veterans about their concerns and preferences.

“We are committed to carrying on with this effort to come up with a standardized VA-wide prescription label that Veterans can use,” she continued, “which we believe can have a significant impact on minimizing the risk of medication errors.”